Approaches to Rehab

When applied to substance use disorders, the term rehabilitation covers the therapy needed after detox to help the individual change their behavior around intoxicating substances like drugs or alcohol.

Addiction is a chronic, complex medical disease involving complex interactions in the brain. It’s influenced by a number of factors, according to the American Society of Addiction Medicine (ASAM), including genetics, the environment, and an individual’s own life experiences.1 People with addiction use substances or engage in compulsive behaviors that often continue despite harmful consequences.1

Once a person has been weaned off their body’s dependence on drugs and/or alcohol to feel normal—the detox process—they must enter a rehabilitation program to learn how to change their behaviors to avoid intoxicating substances and live a healthier life.

There are numerous evidence-based approaches to rehabilitation treatment that will be customized to support your individualized recovery plan to support your liberation from addiction to drugs and/or alcohol. Options include residential live-in, day treatment, intensive outpatient treatment; family and group therapy; “alternative” therapies (e.g., art, music, or yoga); and much more. Each treatment option is designed to equip you with the skills and lifestyle changes you need to stay sober beyond the conclusion of rehab.

Basic Types of Rehabilitation

ASAM recognizes several broad levels of care across a continuum of intensity of services. Patients can move up or down the levels in terms of intensity, and these levels of care are reflected in the continuum of care offerings at Greenhouse:2

  • Medically managed intensive inpatient services: Patients in a medically managed intensive inpatient rehabilitation program reside at the facility for 24/7 monitoring. This level of care ensures medical and/or psychiatric stability, and staff may encourage you to participate in individual therapy, group sessions, and curriculum programing.
  • Residential inpatient services: Patients receiving residential inpatient services reside at a rehab facility and receive 24/7 supervision. The rehab staff ensures your safety and supervises your recovery as you attend therapy sessions, groups and participate in other therapeutic activities.
  • Intensive outpatient/partial hospitalization services: The partial hospitalization program (also called “day treatment” at Greenhouse), is a step down from residential treatment where patients begin the process of reintegration into work, life, and community by attending 3-7 days per week of highly structured treatment in blocks of 6-8 hours in duration. Patients participating in intensive outpatient services have a similar experience as those in partial hospitalization, however, treatment blocks are a minimum of 3 hours in duration.
  • Outpatient services: Standard outpatient services involves regular therapy sessions to keep patient on track and connected to a sober community. At Greenhouse, these sessions are typically weekly.

Behavioral Therapy Types

Different rehabilitation programs often combine different evidence-based therapeutic approaches to treatment, both in group and individual therapy settings.3 The foundational types of therapy used in drug and alcohol rehabilitation include:

  • Cognitive-Behavioral Therapy (CBT) uses positive reinforcement for good behaviors, like avoiding drugs or alcohol, paired with negative reinforcement, like understanding withdrawal symptoms or hangovers as downsides of substance abuse. By identifying maladaptive behavioral patterns, individuals can then apply a range of skills that can be used to drug abuse and a range of other problems that often occur with it.4
  • Motivational Enhancement Therapy (or Motivational Interviewing) has a therapist asking questions to guide an individual to an understanding of how patterns of drug or alcohol consumption cause problematic behaviors, situations, and have long-term health consequences. The focus is on collaborating with the patient, rather than confronting them.2,5
  • Contingency Management uses positive reinforcement in the form of specific rewards, like vouchers or prizes, to help those in therapy feel rewarded for taking appropriate steps in their drug addiction treatment.6
  • Family Behavior Therapy works within the family dynamic, so environmental triggers for addiction and other mental health problems can be understood, behavior can be changed, and trust in the family unit can be rebuilt. This form of therapy also helps the family better support loved ones as they undergo treatment in a rehabilitation program.7

Medication-Assisted Treatment (MAT)

There are several FDA-approved pharmacological treatments available for people struggling with alcohol use disorder, opioid addiction, and tobacco addiction, which can make withdrawal more comfortable and rehabilitation more effective.8 These drug treatments may be used to augment behavioral treatment in your individualized rehabilitation program.9–11 Common drugs used in MAT are listed below:

Indicated for treatment of opioid use disorder:9

  • Methadone
  • Buprenorphine
  • Naltrexone

Indicated for treatment of alcohol use disorder:10

  • Naltrexone
  • Acamprosate
  • Disulfiram
  • Topiramate

Indicated for treatment of tobacco addiction:11

  • Bupropion (Zyban)
  • Varenicline (Chantix)

Holistic Treatment Options

According to the National Center for Complementary and Integrative Health (NCCI), a division of the National Institutes of Health (NIH), more than 30% of American adults use some form of holistic, alternative, or complementary treatment for all kinds of ailments; this includes treatments to overcome substance abuse and maintain sobriety.12

Many rehabilitation programs, including those at Greenhouse, are beginning to use alternative therapies to aid in a more balanced approach to treating the entire individual while they work to end their addiction.2

Some types of alternative treatment options provided by rehabilitation programs include:

  • Mindfulness and meditation techniques help a person become aware of experiences, both thoughts and behaviors, that cause them suffering. By becoming aware of these problems, mindfulness and mediation both promote acceptance and letting go of judgment. This can help a person in a rehabilitation program by acknowledging their substance abuse, lingering issues like cravings or self-blame, and understanding that they can improve their lives.13
  • Music and art therapy can help people relax while they are in rehabilitation, stimulate neurotransmitters so they feel better and more satisfied, and bring groups together by learning instruments, singing, playing music, or creating art together.14
  • Yoga is a form of exercise can range from gentle to vigorous, but it has generally been found to successfully combine stretching and strengthening techniques through holding or working through poses. As a therapy, yoga can improve the body/mind connection, bringing a person into awareness of issues they experience, like withdrawal symptoms or cravings, while helping them improve stamina, balance, strength, and flexibility.15

Equine therapy and pet therapy are two other types of alternative therapies, and although they are not offered at Greenhouse, they are available at other treatment centers within our network.

Mutual Help and Faith-Based Support Groups

A mutual help group is a gathering of similar people who help each other through the recovery process.2 These groups can be an important after a rehabilitation program is completed, so individuals can maintain social support in a group of peers. They can also be a vital component of drug rehabilitation during treatment, especially outpatient treatment.2

Alcoholics Anonymous and the 12-step model has helped people struggling with alcohol use disorder for decades. Many other 12-step-based programs exist today, including

Although Alcoholics Anonymous and the 12-step model is rooted in Christianity and is faith-based, it doesn’t require participants to be a member of a Christianity-based faith—nor any faith for that matter.2 However, there are also other faith-based support groups based upon specific faiths, including:

  • Jewish Alcoholics, Chemically Dependent Persons and Significant Others (JACS), formerly Jews in Recovery, uses founding principles in modern Judaism to help members of the faith overcome addiction to alcohol or drugs. The larger group of programs offer support and guidance through Judaism, with an evidence-based understanding of addiction as a disease and how chemical dependency can affect the Jewish community.
  • Millati Islami is a Muslim-based fellowship of men and women supporting each other through recovery and ending addiction to intoxicating substances, using the Path of Peace and other principles of Islam. Although the central faith is Islam, the philosophical foundation of the support group is based in the 12-step model.

Alternative Mutual Help Programs

Mutual help groups are often rooted in the 12-step model, but some have moved away from the faith-based program while retaining the idea that working together and supporting each other through recovery improves outcomes.16

Self-Management and Recovery Training (SMART) uses four steps to help those in the mutual help group maintain abstinence from alcohol or drugs by supporting changes in self-defeating thinking, emotions, and actions. There are in-person meetings all over the U.S., and meetings are also available online.

Steps-based programs do not work for everyone; instead, a more generally supportive approach to maintaining abstinence or overcoming relapse works better for some. These programs do not rely on steps, but they still provide effective support for overcoming addiction and maintaining abstinence.

  • LifeRing is a secular mutual help group that shares practical experiences, asks questions, and guides members with the understanding that each individual has the ability to stay sober, with social support.
  • Moderation Management focuses on helping people who binge drink, drink heavily, or have other symptoms of problem drinking to curb their alcohol consumption and avoid alcohol use disorder.
  • Rational Recovery is a nationwide support group based on a bestselling book that uses evidence, like changes to the reward system of the brain, to approach a better understanding of what addiction is and how it affects behavior and psychology.
  • Women for Sobriety is a mutual support group founded in 1976 specifically for women suffering from alcohol use disorder. The program has expanded to support women who want to overcome other kinds of substance abuse as well, including benzodiazepine, opioid, cigarettes, and cocaine addictions.

Online Support Groups

Although many people benefit from attending in-person mutual support groups, some people travel for work and others may simply live too far away from a meeting. Fortunately, in an age where technology facilitates online access, many people have started support groups online:

  • AboutAlcoholism is an online message board for those overcoming alcohol use disorder, with a section for loved ones too. One section is specifically related to the 12 steps while the general discussion and other areas do not focus on this type of support group.
  • StepChat is a collection of steps-based online forums offering consistent support from individuals all over the world, not just the United States.

Paying for Rehab

Although most insurance programs, states and Medicaid programs provide some coverage for substance abuse treatment programs of all kinds, there are specific populations who may need additional help. There are many options available and we encourage you to reach out via our Payments Options page or by calling our admissions navigators at 972-848-0260.

References

  1. American Society for Addiction Medicine. (2019). Definition of Addiction.
  2. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
  3. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide: Evidence-Based Approaches to Drug Addiction Treatment.
  4. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide: Cognitive-Behavioral Therapy.
  5. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide: Motivational Enhancement Therapy.
  6. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide: Contingency Management Interventions/Motivational Incentives.
  7. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide: Family Behavior Therapy.
  8. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide: Pharmacotherapies.
  9. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide: Opioid Addiction.
  10. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide: Alcohol Addiction.
  11. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide: Tobacco Addiction.
  12. National Center for Complementary and Integrative Health. (2019). Complementary, Alternative, or Integrative Health: What’s In a Name?
  13. Priddy, S. E., Howard, M. O., Hanley, A. W., Riquino, M. R., Friberg-Felsted, K., & Garland, E. L. (2018). Mindfulness meditation in the treatment of substance use disorders and preventing future relapse: neurocognitive mechanisms and clinical implications. Substance Abuse and Rehabilitation, 9, 103–114.
  14. Aletraris, L., Paino, M., Edmond, M. B., Roman, P. M., & Bride, B. E. (2014). The use of art and music therapy in substance abuse treatment programs. Journal of Addictions Nursing, 25(4), 190–196.
  15. Sarkar, S., & Varshney, M. (2017). Yoga and substance use disorders: A narrative review. Asian Journal of Psychiatry, 25, 191–196.
  16. Beck, A. K., Baker, A., Kelly, P. J., Deane, F. P., Shakeshaft, A., Hunt, D., … Kelly, J. F. (2016). Protocol for a systematic review of evaluation research for adults who have participated in the ‘SMART recovery’ mutual support programme. BMJ Open, 6(5), e009934.
About The Contributor
Ryan Kelley, NREMT
Medical Editor, American Addiction Centers
Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series... Read More